Pile Driver Skill Sheet Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Primary phone number*Primary phone type*HomeCellOther phone numberOther phone typeHomeCellEmail UBC ID#*Local Union #*Ethnicity Asian Hispanic Caucasian African-American Native American Other OtherAre you a veteran?YesNoSkillsYou have experience to accept work in the following:Check all that apply. Auger Cast (AUGER) Bilingual - Spanish (SPANISH) Concrete Forms (FORMS) Diver (DIVER) Drilling Experience (DRILL) Foreman (COMFOR) Front End Man (FRTEND) Layout from prints (COMLAY) Marine Floating Rig (MARINEFLT) Pin Pile (PINPILE) Sheet Piling (SHEETPILE) Timber Work (TIMBERWK) You are trained/certified in the following: Check all that apply. Fall Protection (FALLP) First Aid/CPR (FIRSTAID) Hazardous Waste Worker (HAZWW) MSHA (MSHA) Pro 10 (PRO10) Please indicate the welding ability you hold: Please make sure your records are up-to-date.Welding Experience: AIR/ARC ARC/STICK MIG TIG Welding Certificate: ARC/STICK MIG TIG Work areasCheck your PRIMARY work area.*Check ONLY ONE. Refer to the area map found at www.northcountrycarpenter.org/mix2020Area 45Area 46Area 47Area 48Area 49Area 50Area 51Area 52Area 53Area 54Area 55Area 56Area 57Area 58Area 59Area 60Area 61Area 62Area 63Area 64Area 65Check any other areas in which you are willing to work.Check as many as apply. Refer to the area map found at www.northcountrycarpenter.org/mix2020. Area 45 Area 46 Area 47 Area 48 Area 49 Area 50 Area 51 Area 52 Area 53 Area 54 Area 55 Area 56 Area 57 Area 58 Area 59 Area 60 Area 61 Area 62 Area 63 Area 64 Area 65 Type your name below:*By typing my name below, I consent to be contacted via telephone, email, cell phone or text message by the United Brotherhood of Carpenters and Joiners of American and its affiliates, including by auto-dialed or pre-recorded calls. (Please note message and data rates may apply.) I agree that this authorization is in effect until I provide written revocation to NCSRCC, 700 Olive Street, Saint Paul, MN 55130. In addition, I declare that the above skills information is correct to the best of my knowledge.